Healthcare Provider Details

I. General information

NPI: 1164098448
Provider Name (Legal Business Name): CALIFORNIA IMAGING & DIAGNOSTICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25470 MEDICAL CENTER DR STE 101
MURRIETA CA
92562-4901
US

IV. Provider business mailing address

1545 W FLORIDA AVE
HEMET CA
92543-3814
US

V. Phone/Fax

Practice location:
  • Phone: 951-816-3268
  • Fax: 951-894-1842
Mailing address:
  • Phone: 951-791-1111
  • Fax: 888-856-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSIE GARCIA
Title or Position: MANAGER
Credential:
Phone: 951-791-1111